{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T22:13:04Z","timestamp":1783548784280,"version":"3.55.0"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T00:00:00Z","timestamp":1676419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["UG3HD096875"],"award-info":[{"award-number":["UG3HD096875"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"Family-based interventions may help reduce the risk of HIV and other sexually transmitted infections (STI) among adolescent girls and young women (AGYW) in sub-Saharan Africa but few have been tested. We examined the preliminary effectiveness and implementation outcomes of I<\/jats:italic><\/jats:underline>nformed<\/jats:italic>, M<\/jats:italic><\/jats:underline>otivated<\/jats:italic>, A<\/jats:italic><\/jats:underline>ware<\/jats:italic>, and<\/jats:italic> R<\/jats:italic><\/jats:underline>esponsible<\/jats:italic> A<\/jats:italic><\/jats:underline>dolescents and Adults\u2014<\/jats:italic>S<\/jats:italic><\/jats:underline>outh<\/jats:italic> A<\/jats:italic><\/jats:underline>frica (IMARA-SA)<\/jats:italic>, an evidence-based intervention for South African AGYW (15\u201319 years) and their female caregivers. We piloted IMARA-SA in the Western Cape using an individually randomized experimental design and average follow-up at 11 months. Primary outcomes were HIV Testing and Counselling (HTC) uptake, STI incidence (gonorrhea, chlamydia), and pre-exposure prophylaxis (PrEP) uptake. Secondary outcomes were self-reported sexual risk behavior (condom use at last sex, consistency of condom use, substance use during sex, and number of sexual partners) and PrEP adherence. We examined four implementation outcomes: reach, feasibility, acceptability, and fidelity. Data from 59 AGYW (mean = 17.2 years) were analyzed at baseline (n = 29 from IMARA-SA, 30 from a health promotion control group). At follow-up, 51 (86%) completed surveys and 39 (66%) presented for HTC, STI testing, and\/or PrEP. Compared to controls, fewer IMARA-SA participants tested positive for an STI (22% versus 38%), more IMARA-SA participants took up PrEP (68% versus 45%), and four of five secondary outcomes favored the IMARA-SA group at follow-up. These differences did not reach statistical significance. HTC uptake at follow-up was 100% in both groups. All AGYW-FC dyads agreed to participate in the study (reach). In the IMARA-SA group, 76% of dyads completed the intervention (feasibility), and over 76% of acceptability ratings from AGYW and their FC had the highest Likert rating. Fidelity of intervention delivery was 95%. IMARA-SA is a promising strategy for reducing HIV\/STI risk among South African AGYW. We found strong evidence of reach, feasibility, acceptability, and fidelity. A fully powered randomized controlled trial is warranted.<\/jats:p>\nTrial registration: Clinical trials.gov registration number:<\/jats:bold> NCT05504954<\/jats:ext-link>.<\/jats:p>","DOI":"10.1371\/journal.pgph.0001092","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T18:33:07Z","timestamp":1676485987000},"page":"e0001092","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Preliminary effectiveness and implementation outcomes of the IMARA-South Africa sexual health intervention on adolescent girls and young women: A pilot randomized trial"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5308-4154","authenticated-orcid":true,"given":"Katherine G.","family":"Merrill","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Millicent","family":"Atujuna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Emerson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dara","family":"Blachman-Demner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany C.","family":"Bray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda-Gail","family":"Bekker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geri R.","family":"Donenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,2,15]]},"reference":[{"key":"pgph.0001092.ref001","author":"UNAIDS","year":"2018"},{"key":"pgph.0001092.ref002","volume-title":"AIDS Info: Indicators","author":"UNAIDS"},{"key":"pgph.0001092.ref003","volume-title":"Country Fact Sheet: South Africa","author":"UNAIDS","year":"2019"},{"issue":"167","key":"pgph.0001092.ref004","article-title":"HIV prevalence in South Africa through gender and racial lenses: results from the 2012 population-based national household survey","volume":"18","author":"M Mambaso","year":"2019","journal-title":"International Journal for Equity in Health"},{"key":"pgph.0001092.ref005","volume-title":"Qualitative Evidence on Adolescents\u2019 Views of Sexual and Reproductive Health in Sub-Saharan Africa","author":"M Amuyunzu-Nyamongo","year":"2005"},{"key":"pgph.0001092.ref006","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1177\/1403494808086986","article-title":"Sociodemographic variations in communication on sexuality and HIV\/AIDS with parents, family members, and teachers among in-school adolescents: A multi-site study in Tanzania and South Africa","volume":"37","author":"F Namisi","year":"2009","journal-title":"Scandanavian Journal of Public Health"},{"key":"pgph.0001092.ref007","doi-asserted-by":"crossref","first-page":"49","DOI":"10.2307\/3583160","article-title":"Parental factors and sexual risk-taking among young people of Cote d\u2019Iviore","volume":"9","author":"S Babalola","year":"2005","journal-title":"African Journal of Reproductive Health"},{"issue":"2","key":"pgph.0001092.ref008","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1363\/3507209","article-title":"Role of parents in adolescent sexual activity and contraceptive use in four African countries","volume":"35","author":"A Biddlecom","year":"2009","journal-title":"Int Perspect Sex Reprod Health"},{"issue":"1","key":"pgph.0001092.ref009","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/1471-2458-10-102","article-title":"HIV prevention for South African youth: which interventions work? 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